Despite major advances in care and treatment for those living with HIV, morbidity and mortality among people living with HIV/AIDS (PLHIV) remain unacceptably high in sub-Saharan Africa (SSA), largely due to the parallel challenges of poverty and food insecurity. Food insecurity and poverty contribute to higher morbidity and mortality among PLHIV, and there has been increasing international recognition of the need to address these factors for a successful global response to the HIV epidemic. Yet, to date there have been few studies to systematically evaluate the impact and cost-effectiveness of promising food security interventions on health outcomes among PLHIV. To address these gaps, together with KickStart, a non-governmental organization based in SSA, we have developed a multisectoral intervention in Nyanza Region, Kenya that includes: a) a microfinance loan (~$175) for purchasing agricultural implements and commodities; b) agricultural implements to be purchased with the loan including a human-powered water pump, seeds, fertilizers and pesticides; and c) education in financial management and sustainable farming practices. We successfully completed an NIH- funded pilot intervention trial that showed that the intervention was feasible, acceptable and may improve HIV- related health. We now plan to conduct a cluster randomized controlled trial (RCT) of this intervention with the following specific aims: Ai 1: To determine the impact of a multisectoral agricultural intervention among HIV- infected farmers on ART on HIV clinical outcomes. We hypothesize that the intervention will lead to improved viral load suppression (primary outcome) and decreased HIV-related morbidity in the intervention arm